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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 9, 1237-1242.
doi: 10.1302/0301-620X.91B9.22051  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Neutrophil CD64 expression in the diagnosis of local musculoskeletal infection and the impact of antibiotics

S. Tanaka, MD, PhD, Associate Professor1; J. Nishino, MD, Orthopaedic Surgeon2; T. Matsui, MD, PhD, Rheumatologist3; A. Komiya, MD, PhD, Rheumatologist3; K. Nishimura, MD, PhD, Professor4; and S. Tohma, MD, Director3

1 Department of Orthopaedic Surgery, Faculty of Medicine The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
2 Nishino Clinic of Orthopaedics and Rheumatology, 2-9-15 Nishigaoka, Kita-ku, Tokyo 115-0056, Japan.
3 Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital, National Hospital Organization (NHO), 18-1 Sakuradai Sagamihara City, Kanagawa 228-8522, Japan.
4 Department of Orthopaedic Surgery Teikyo University School of Medicine, Tokyo 173-8605, Japan.

Correspondence should be sent to Dr S. Tanaka; e-mail: TANAKAS-ORT{at}h.u-tokyo.ac.jp

We examined the usefulness of neutrophil CD64 expression in detecting local musculoskeletal infection and the impact of antibiotics on its expression. Of 141 patients suspected of musculoskeletal infection, 46 were confirmed by microbiological culture to be infected and 95 had infection excluded. The median CD64 count of patients with localised infection was 2230 molecules per cell (interquartile range (IQR) 918 to 4592) and that of the patients without infection was 937 molecules per cell (IQR 648 to 1309) (p < 0.001). The level of CD64 correlated with the CRP level in patients with infection, but not in those without infection (r = 0.59, p < 0.01). Receiver operator characteristic curve analysis revealed that CD64 was a good predictor of local infection. When the patients were subdivided into two groups based on the administration of antibiotics at the time of CD64 sampling, the sensitivity for detecting infection was better in those who had not received antibiotics.

These results suggest that measurement of CD64 expression is a useful marker for local musculoskeletal infection.




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Confidence intervals matter
Yu-Min Lin, et al.
J Bone Joint Surg Br Online, 26 Jan 2010 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General